OA05.7. Prognostic Implications of Circumferential Resection Margin (CRM) After Curative Esophagectomy – a Retrospective Analysis

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ID: 325904
2026
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Ranked #131 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Obtaining a negative CRM is critical in esophageal cancer surgery as it dictates prognosis but confusion remains due to different definitions. This study aims to evaluate the prognostic impact of two separate definitions of negative CRM by College of American Pathologists (CAP) and Royal College of Pathologists (RCP). Methods This is a retrospective analysis of patients with carcinoma esophagus who underwent curative esophagectomy between 1st January 2010 and 31st December 2021. Demographic, clinical and pathological data was collected and pathological review was done for patients where definition of CRM was not clear from histopathology. Entire cohort was divided into 3 groups: a) CRM negative (negative by RCP criteria) i.e. margin >1mm, b) CRM close (negative by CAP criteria but positive by RCP) i.e. margin <1mm but >0mm and c) CRM positive i.e. tumor at margin. Overall and Disease free survival were estimated using Kaplan-Meier method and curves were compared between groups using log rank tests. Follow up was performed till September 2025. Results Out of 1848 patients, 1433 (77.5%) patients were CRM negative, 285 (15.4%) CRM close and 130 (7.03%) CRM positive. T3 tumors were significantly higher in CRM close (84.9% vs 33.9%, p<0.0001) than CRM negative group. Similarly, CRM close group had higher nodal positivity (36.2% in CRM negative vs 59.6% in CRM close; p<0.001), TRG>= 3 (95.6% vs 59.5; p<0.001), Lymphovascular invasion (36.2% vs 17.1%, p<0.001) and Perineural invasion (34.9% vs 16.2%, p<0.001) as compared to CRM negative group. Pathological complete response in CRM negative was 24.4% vs 0% in CRM close and positive (p<0.001). After a median follow up of 89.6 months, the median OS of the entire cohort was 69.9 months (95% CI, 58.2-87.5) while the patients with a CRM negative status had a significantly better survival of 104.8 months (95% CI, 90.5-161.4) in comparison to the patients with a CRM close 27.4 months (95% CI, 21.8-33.6), p<0.0001. Conclusion This study confirms the prognostic and predictive value of close and positive CRM. Involvement of CRM by the RCP as well as CAP definition denotes an aggressive group tumors that have poor response to neoadjuvant therapy. These patients have poor long term outcomes hence intensification of perioperative therapy in this cohort needs to be explored.
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Authors Aditya Singh, Sabita Jiwnani, Karthik V, Salma S, Rajiv Kaushal, Akanksha Kaushik, D. Niyogi, VirendraKumar Tiwari, C S Pramesh
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.041
URL
https://doi.org/10.1093/dote/doag077.041
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